Healthcare Then and Now (Pedcast)


Sometimes I daydream about my career and how things have changed during my time in pediatrics… and boy, have things changed. When I started in pediatrics in 1982, I wore a lot of doctor hats: I functioned as office pediatrician, delivery room doctor, neonatologist, PICU doctor, a pediatric hospitalist, a pediatric ED physician, an after-hours phone triage nurse, and occasionally an assistant doctor in the operating room. A child came down with meningitis…they were mine to care for. An infant was born prematurely and needed NICU care…Doc Smo was on the case. Johnny had a near drowning event at the local pool and needed care in the pediatric ICU… you got it, they were mine as well. Well, you get the idea.

I am board certified, I meet national standards of care, and I participate in continuing education of all sorts, but I am not a sub-specialist. I was trained in general pediatrics. I provided general pediatric care. In 1982, my patients got good care that met the standards of the day, but you could argue it was not the kind of care children get in the same community 32 years later. Let’s break that down a little further, shall we? Specifically, let’s compare the healthcare world of 1982 with the healthcare world of 2014.


Better pay in 2014:

First let’s start with salary. My starting salary in 1982 was $36,000; fairly good for the time. I was working a minimum 60-80 hours a week and taking a lot of risk in a difficult, physically demanding job. When my partners hired me, my senior partners were making $60,000/ year in 1982. Using an inflation calculator, my partner’s $60,000/ year in 1982 would need in 2014 dollars to be paid $147,000. Today’s pediatricians actually have are making an average of $177,000/year. That translates to an annual 1% raise over their 1982 counterparts.



Sickness down, Diagnostics better:

Here’s another big difference…children aren’t nearly as sick as they used to be in 1982. Vaccines have taken almost all septic illness off the table for children, which is a great thing. Children today rarely get bacterial meningitis or other “septic” life-threatening illness. And if they do get sick, office diagnostic tools are far better at assisting pediatricians with diagnosis. Automated blood counting machines, sophisticated hospital labs with couriers, and easy access to X-ray and ultrasound studies have really improved things for doctors and sick children.


Better informed patients and doctors:

Rapid access to the latest information has revolutionized the practice of medicine for both doctors and patients. With a few strokes of the computer keys, I can get access to the best and most recent information on really any topic I wish to explore. And patients can get the same thing. My patients are much better informed than a few decades ago, when they had to rely on me and my research for guidance. Often in today’s world, families know more about a particular disease of condition than I do. I feel like instead of providing information, perspective, and judgment like I did in 1982, today all I have to offer families is perspective and judgment…still useful, but my knowledge is not as much in the center of the vortex as it used to be.



So what does this all mean? I was providing a lot of care in 1982, but not of equal quality and sophistication as that being provided in 2014. I was a bargain however. In today’s dollars, I was being paid $49/hour in 1982 compared with current pediatricians, who are being paid $62/hour.


So how has healthcare changed during my pediatric career? I think by looking at tenure in medicine in the US, you can see the big trends healthcare.


  1. Overall, healthcare is just a lot more expensive because of increased sophistication and technology that is being offered today. We are just not comparing 2014 apples with 1982 apples. The technology and expertise you are buying when you walk into a healthcare facility is much more sophisticated in 2014 than it was in 1982…you are literally getting more! In a town like Charlotte, rather than seeing little old me when you are sick in the ED or give birth to a premature infant, now you are greeted by subspecialty trained and certified specialists, ready with the latest equipment and support staff…Cha-ching, cha-ching.


  1. Vaccines have revolutionized pediatrics, pure and simple. Children just don’t get the terrible bacterial infections that were so common a generation ago, because vaccines have done such a great job of protecting them.


  1. Parents and doctors have much better access to cutting edge information about diseases and therapies. Literally within seconds, the latest information on *whatever* can be delivered to the bedside. Amazing.



  1. Unfortunately, the widespread practice of defensive medicine continues to be felt as much by today’s doctors as it was in 1982. Ordering tests and procedures that are unlikely to yield useful information for a patient, but rather serve to protect a physician continues to be a tremendous drain on our resources. Plaintiff’s attorneys continue to be the boogie-men in every doctor’s closet. Cha-ching


  1. And finally, in the name of good intentions, government regulation has exploded… electronic medical records, privacy compliance, laboratory standards compliance, licensure, board certification, maintenance of certification, just to name a few. Money well spent… maybe, but I’m not so sure? Cha-ching.


So here we are, in 2014, with healthcare almost unaffordable for everyone. Are we better off than we were in 1982 world of healthcare with little old me doing the heavy lifting? In many respects yes, but in others, I am really not so sure. I have been joking with my friends for years that in the future, we will be able to cure the horrible cancers and diseases of today, insert new genes into children with genetic diseases, and regenerate malfunctioning organs with stem cells, but will anyone be able to afford these cures? I certainly hope so.


Thank you for joining me today for this edition of I would love to hear your perspective on healthcare, pediatrics, and the future of pediatrics. Take a minute to send me a comment via Facebook, Twitter, or at my blog, This is Doc Smo, hoping we all take great care, when we design the future of healthcare. Until next time.